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Similar logic to that described above would apply if other numbers of vaccines were to be chosen.

Sensitivity Analyses

Adoption of Age-Neutral Versus Committee Median Perspective

The age-neutral perspective on morbidity and mortality was adopted as an alternative to the committee median perspective (see Chapter 4 for explanation of these perspectives). The results are shown in Chapter 7 and Tables 9.1 and 9.2.

Use of the age-neutral perspective IME values does not markedly change the selection of the top five. For any willingness to pay to save an IME of at least $125,000, the priority list remains:

Hepatitis B

RSV (ALV)

H. influenzae type b

Influenza

Varicella (high-risk individuals)

The ALV influenza vaccine would be preferred over the subunit vaccine unless one were willing to pay more than $1.2 million per incremental IME saved. Parainfluenza vaccine would displace H. influenzae type b if the willingness to pay per IME saved were less than $125,000; streptococcus group B vaccine would replace hepatitis B vaccine if the willingness to pay were as little as $6,000; none of the other vaccines would become contenders for the top five positions at any willingness to pay. Thus, for the candidates considered, the ranking of the top five vaccines does not depend on whether the committee median weights or the age-neutral weights are used.

Discount Rate

The committee believes that incorporation of a discounting procedure for future health benefits and costs is justified because it reflects the preference for benefits achieved sooner rather than later (a basic concept in the establishment of a program of accelerated vaccine development). The effect of placing greater or lesser weight on achieving early benefits was examined by selecting discount rates higher (0.10) and lower (0.02) than that used in the central analysis.

The results with these discount rates are compared to the central analysis in Tables 9.4 and 9.5.

Using discount rates of 10 percent or 2 percent would not materially affect the rankings, nor would it affect the choices of the top five.



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